Hi all,
I recently came across 'The Linden Method' (TLM), knew nothing about it, and thought I'd have a look into it. A cursory read around the Net threw up some red flags for me. Of course, 'methods for managing anxiety' is a subject which interests many of our members, so I checked for instances of TLM being discussed at BB - there were quite a few of them over the years. Although such threads at BB have been fairly infrequent, and the response to the product has been, on the whole, pretty muted, I thought I should look into this further. When I read the 'method' in more depth, I realised that our members really should be warned about this product.
I do not propose to disallow discussion about TLM at BenzoBuddies, but we will remove links to the product (not that this has been an issue so far). Despite the claims made by TLM, there have been
no scientific trials into efficacy, and TLM do
not have accredited psychotherapists working as part of the package. Further, in the UK, TLM has failed to comply with the Advertising Standards Agency (ASA) about their use of baseless claims in marketing literature. Although it is not unusual for companies to fall foul of the ASA, it is very unusual for one to refuse to comply with ASA rulings. This is another reason to not trust TLM.
In addition to TLM not being scientifically scrutinised, false claims about their 'registered psychotherapists', and false advertising, Charles Linden (not his real name, by the way) demands that his customers do not consult with their doctors, and he rubbishes Cognitive Behavioural Therapy (CBT) as unscientific, when in actuality and objectively, it is one of the most effective therapies in the treatment of anxiety. Further, without even a hint of embarrassment, (by all accounts) Linden then makes liberal use of basic CBT methods within his product.
There is little point in me writing further about this when others with infinitely more knowledge about anxiety management and information about the product have taken TLM to task. I will first point to some feedback comments about TLM at Amazon, including some rather unfortunate and telling remarks from Charles Linden himself.
This Amazon review is from someone called 'Andrew E'. His comments mostly consist of a quote from Prof. Salkovskis. The review does, however, set up later comments from Charles Linden. I've not read all the way through the comments - I became bored with Linden's refusal to supply the scientific data he claimed to hold for his product (I think I gave up around page 5 or 6 of the comments).
http://www.amazon.co.uk/review/R22P9K96N603K1/ref=cm_cr_rdp_perm?ie=UTF8&ASIN=0954980301I instead decided to look up Professor Paul Salkovskis. Prof. Salkovskis is an expert in the field anxiety, and was asked by the National Phobics Society (now AnxietyUK) if he would review TLM. With Prof. Salkovskis's approval, a copy of his original review appears below. I then include links to each entry in his series of follow-up blog articles about what has transpired since his review was originally published in 2005, and one additional link to a review by AnxirtyUK about the decision by ASA regarding TLM's advertising practices.
I just wish to add, for anyone reading this who might have experienced some benefit from TLM, there is nothing to worry about. It would seem that, contrary to Linden's comments about CBT, TLM is
grounded in CBT. And, despite Linden's claims about CBT being ineffective and unscientific, the opposite is true. For those who might be considering TLM, it seems that you can find other (and better) information elsewhere, for much less money or even for free.
I'd like to thank Prof. Paul Salkovskis for taking the time to review (and debunk) TLM and providing such a thorough update at his blog last year.
From:
psychonoclast's Blog
Mental Health, the NHS, Clinical Psychology and suchThe Linden Method: Review Originally published in “Anxious Times” in 2005/6
April 25, 2014
This review was carried out at the request of the National Phobics society (now re-named AnxietyUK). On re-reading it, I can recall straining to find helpful “nuggets” in it. Although I didn’t do this at the time, I would estimate that had I rated it I would have given it 1/10, and that one is for the “nuggets” which are as far as I can see, borrowed from elsewhere. It seems to me what’s new in TLM is not effective, and what’s effective is not new.
Several times it has been suggested that I had not made contact or allowed for the support offered by phone or on-line. This is, in my view, a silly critique. Even if we leave aside concerns about the credentials claimed for some of the support team.
Support for a programme of this kind would be to help the person experiencing the anxiety problem to better implement the programme as set out in the materials I had. My review was of the core, and would be entirely unaffected by any additional support which may or may not be accessed by those trying to make sense of the Linden Method.
Why reproduce this review now? Well, over the years various attempts have been made to suppress this review and people who have reproduced online it have been threatened with legal action (not by me!!) if it was not removed from their bulletin boards and so on, so I thought it would be helpful to put it somewhere where I am responsible for it. So here it is. Shortly I will be adding a longer post detailing some more recent issues with the Linden Method. But for now…
The NPS as was (AnxietyUK now) prefaced the print of my review with the following:
“Following on from the many enquiries received on the helpline on the Linden Method, we asked 3 people – 2 National Phobics Society volunteers (Rachel Fitzsimmons and Dave Davies) and a patron of NPS, Professor Paul Salkovskis to review the programme, Professor Paul Salkovskis review is as follows and has been chosen to be printed because both volunteer reviews were disputed by Mr Linden on the grounds that the first volunteer didn’t suffer with panic attacks and therefore couldn’t accurately assess the package. The 2nd volunteer review was rejected because Mr Linden felt that being a sufferer of an anxiety disorder wasn’t sufficient qualification to review the package”:
Extraordinary Claims Require Extraordinary Evidence
Paul Salkovskis, Clinical Director, Maudsley Hospital Centre for Anxiety Disorders and Trauma
The Linden Method
The claims made in this programme are bullish. We are asked to believe that this is the one true way to rid yourself of panic attacks, anxiety disorders and phobias. At one point it says that it is the only cure for anxiety. But before looking at the evidence for such extraordinary claims, let’s look at the process.
Firstly, one has to learn the “nine pillars”, read the material, do the visualisation exercise twice each day, do Tai Chi exercises as often as possible and do exactly what the Method teaches you. Confusingly, there are then two “powerful” elements; diversion which apparently re-balances the sufferer’s conscious logical thinking and subconscious habits. Secondly, the sufferer needs to breathe correctly and improve their posture.
So what are the nine pillars?
Stop visiting your doctor (and other doctors too)
Talk to your doctor about stopping the medication (confusingly as you are not supposed to visit them)
Stop looking for answers to your problems elsewhere
Only use the Linden method
Stop talking to other people about how you feel
Stop relying on other people for help with your feelings (which follows from not talking to them presumably)
Get rid of memories about your problem
Keep busy as a diversion (distraction)
Don’t allow anxiety to change what you do.
You don’t have to be a psychologist to see that 1-7 are all ways of saying “rely on the this method alone”. That leaves two pillars which are about not giving in to anxiety. Good stuff, but not good enough.
Interestingly for someone who says that the way to getting better is not to dwell on the details of your past problems, Mr Linden offers the story of his own problems in great detail in the “Nine Pillars” booklet. The story comes to its culmination when he received Cognitive-behaviour Therapy. His cognitive therapist taught him all kinds of useful stuff, which Linden applied and added to. I found myself musing about this. Why is this person, who benefited from cognitive therapy (and added to it in ways any sensible CBT therapist would encourage one to do) now taking the position that other people should not seek help from anyone except himself? I’m keeping my answers to myself, I’m afraid.
The Nine Pillars book then offers a reasonable account of the physiology of anxiety (although some of it made me wince). Nothing unique here, and certainly not the best account available. For someone opposed to the use of medication Linden seems very fond of biological accounts of anxiety. Oddly, although he seems to have benefited from cognitive-behavioural therapy, the cognitive component does not come through directly. For example, this early section on Panic Disorder he neglects to mention catastrophic misinterpretation of bodily sensations, choosing instead to suggest that the brain has been programmed to produce panic. Linden is also fond of diagnosis, and paraphrases the American diagnostic system as a way of describing anxiety disorders. This improves later as one listens to the CD based material, but the nuggets are well hidden.
The chapter on stopping anxiety has some good snippets, and Linden is fond of the idea of hyperventilation, resurrecting the old “brown paper bag” idea. Some other practical ideas are to be found in “diversion tactics”; these are good old fashioned distractions, varying from splashing water on the face to eating apples. Maybe he thinks an apple a day keeps the doctor away, so it fits with his first pillar? But there is another major problem here. He gives no consideration to safety seeking behaviour. This is a shame, because a lot of his “behavioural activation” stuff (meaning: don’t let your behaviour be changed, reach for the things you want) fits with current views on and evidence about the role of safety seeking in anxiety disorders. However, in places he is implicitly encouraging safety seeking behaviours. This in my opinion is further evidence that Linden’s science is, as best, muddled.
The supplementary materials are interesting. The introduction on the CD is a pleasant and slightly soporific lecture which re-iterates the positive message in the nine pillars book. In the interview which follows, we are treated to more of the same. The visualisation exercise is even more soporific. It follows the convention set by progressive muscular relaxation, and again is worth doing for its relaxation and distraction potential, if relaxation and distraction is what you need.
The “Panic Attack Eliminator” seemed more promising on the basis of its preamble. And I mean promising; the promise is there, right at the beginning; “this is the conclusive method for disarming panic attacks”. Apparently it can work on the first occasion, but might take up to three times. In the rest of this seven minute wonder, the sufferer is told that they cause their own panic. “Place every square millimetre of your body in my trust” Linden intones. Go with it, let it do its worst. Discover that it can’t do anything bad to you. At last, something resembling cognitive therapy! Not set up properly, but sensible. Fear of fear is emphasised, as are vicious circles. But they are not explained properly, and of course it is not fear of fear which is the problem in panic, but fear of the consequences of fear. Sadly, it is clear that this is not the conclusive method.
This is all a bit sad. One way of looking at it is that Charles Linden had cognitive behavioural therapy, found it helpful, embellished it and now markets it as his own one true way not just for the problem he had, but for all anxiety problems. It’s not.
Now don’t get me wrong, this is mostly sensible stuff for panic, and if it cost £5.99 at the bookshop, I’d be recommending it, suggesting that there might be useful snippets here and there.
My opinion is that it will be of no value to people whose anxiety is not fuelled by panic, and only limited value to most of those with severe and persistent panic. So would I recommend it in a limited way?
What makes any recommendation impossible is the cultic element. The explicit method is, use my method only (and pay my price for it). The National Institute for Clinical Excellence (NICE) anxiety guidelines are now available, summarising the best science. Cognitive behaviour therapy (CBT) is the treatment of choice. The Linden Method has no evidence underpinning it and therefore doesn’t even make third choice for NICE, which is guided self help based on CBT principles. Charles Linden’s method is not evidence based, the science is flawed and the price is ludicrous. In essence Linden claims this treatment is novel and effective; sadly, it seems likely that what is novel is not effective, and what is effective is not novel. My title for this review is that extraordinary claims require extraordinary evidence; there is no such evidence
Professor Paul M Salkovskis
Summary of an overview of the Linden Method: my contact with it, some facts and some personal opinion1. Part 1 The History of my early contact with the Linden MethodPart 2: What else was happening in the meantime around the Linden Method?Part 3: More recent events and Charles Linden’s critique of Paul Salkovskis’ previous review of the Linden Method.Part 4: Linden Method support staffing offering “unlimited reassurance” and their professional “accreditation”Part 5: Is there “science” behind the Linden Method?Part 6 Linden Method “data”; or is it?Part 7: Stop the WordPresses! More Linden Method Science….or is it? And “charitable” efforts too!And AnxietyUK's review of the ASA decision (page 13):
https://www.anxietyuk.org.uk/wp-content/uploads/2010/11/Spring-2012-Anxious-Times.pdf
